Which intervention is contraindicated in pregnancy for nephrolithiasis?

Which intervention is contraindicated in pregnancy for nephrolithiasis?

• A. Ureteroscopy with stent placement
• B. Nephrostomy tube placement
• C. Shockwave lithotripsy
• D. Medical expulsive therapy with alpha blockers

Answer: (C)

When treating kidney stones in pregnancy, the priority is to decompress the urinary tract while minimizing fetal risk. Shockwave lithotripsy uses external energy to fragment stones and typically involves imaging with fluoroscopy, exposing the fetus to ionizing radiation and energy delivery near the uterus. That combination makes it contraindicated during pregnancy because of potential fetal harm and maternal complications. In contrast, relieving obstruction with a ureteral stent or a percutaneous nephrostomy can be done with careful technique and imaging choices (often ultrasound guidance) to limit fetal exposure, making these approaches preferable when intervention is needed. Medical expulsive therapy with alpha blockers carries insufficient safety data in pregnancy, so it is not the go-to choice for acute management.

When treating kidney stones in pregnancy, the priority is to decompress the urinary tract while minimizing fetal risk. Shockwave lithotripsy uses external energy to fragment stones and typically involves imaging with fluoroscopy, exposing the fetus to ionizing radiation and energy delivery near the uterus. That combination makes it contraindicated during pregnancy because of potential fetal harm and maternal complications.

In contrast, relieving obstruction with a ureteral stent or a percutaneous nephrostomy can be done with careful technique and imaging choices (often ultrasound guidance) to limit fetal exposure, making these approaches preferable when intervention is needed. Medical expulsive therapy with alpha blockers carries insufficient safety data in pregnancy, so it is not the go-to choice for acute management.